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HomeMy WebLinkAbout010-1041-20-100 II ~ o i ~ °o, I o c i 00 4 ~ I 0 o I N N I o~ I h I ti I I I (D a z c ti c O 3 I I I v a3i I w z y co z o v p z a co z o I o z v r LO o d z ~ ~ CD z I 2 - 0 m o Cl) 7 .5 1 CL ID (D I G 0 c 01 O O N R Q N C> H Z LO z i > c c c N'> R E c N C ILl R L m 3 as - o U I d v a : . cD (0 0) i R N y R vy i c O O O m {GS. G a N N Z r Q> = U Z N N 4 J O O • C) a a a y U) J U ! N rn rn } ~ N I 'mil O N O to co 0 5 CC .0 co R CL Q) O 'C m N m •p d Q } Cn R O y y U CD o a a c Q ~Ql o o c t c" u a. N 00 l N C, V v ~O v Y c aCi o O N N d1 N N • O W U) CL o O Z UO) ~J u) Ca i a Ll L: a • u rrww• cl O. 0) y C _1 A ciao oac°) Parcel 010-1041-20-100 06/27/2006 08:03 AM PAGE IOF 1 Alt. Parcel M 17.30.16.249A 010 - TOWN OF EMERALD Current X'I ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - SPEER, KENNETH&RENE HAMMARBACK- TR KENNETH&RENE HAMMARBACK- TR SPEER PO BOX 623 BALDWIN WI 54002 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * CTY RD SC 2198 GLENWOOD CITY SP 1700 WITC Legal Description: Acres: 9.995 Plat: N/A-NOT AVAILABLE SEC 17 T30N R16W PT NW NE BEING LOT 1 OF Block/Condo Bldg: CSM 9/2620 9.995 ACRES Tract(s): (Sec-Twn-Rng 401/4 1601/4) 17-30N-16W Notes: Parcel History: Date Doc # Vol/Page Type 08/04/2005 802398 2858/493 QC 10/07/1998 588538 1363/318 TD 07/23/1997 1094/134 QC 07/23/1997 1094/133 QC 2006 SUMMARY Bill M Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 11/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.000 22,500 325,000 347,500 NO AGRICULTURAL G4 6.950 600 0 600 NO Totals for 2006: i General Property 9.950 23,100 325,000 348,100 Woodland 0.000 0 0 Totals for 2005: General Property 9.950 23,100 325,000 348,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 213 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 ~ r STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER Y, Ili ADDRESS_ 6 ';2 SUBDIVISION / CSM# LOT # SECTION-. 1:7 T V N-R[_(_ OW Town of -e rcA c1 ST. CROIX COUNTY, WISCONSIN PLAN'VIEW SH W VERYTHING WITHIN 100 FEET OF SYSTEM i - - ~ is ~U P ` r: 7 ' .1a INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover- BENCHMARK: ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING-TANK INFORMATION Manufacturer: W ~l S e r Liquid Capacity: acv p• ( ()K4~ Setback from: Well t 00 House_ other Pump: Manufacturer 2o-e l l -c t-- Modell S- ?-2 Size_ Float seperation c ` Gallons/.cycle: ((~C~ Alarm Location SOIL ABSORPTION SYSTEM Width: 5 Length "4 Number of trenches Distance & Direction to nearest prop. line: r Setback from: well:('' Q House Other ELEVATIONS Building Sewer ST Inlet: C Q 8ST outlet PC inlet PC bottom ( Pump Off ~ , c3 Header/Manifold Bottom of system /bo?.S' Existing Grade Final grade " l0l°S DATE OF INSTALLATION: T PLUMBER ON JOB: LICENSE NUMBER: f-) j INSPECTOR: AA- 3/93:jt Wiscdnsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION Pgrmit Holder's Name: ❑ city Village -FOC6n/~f: State Plan ID No.: CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA g y TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 4L -ear/ &w% - 7_60i Benchmark 3 "13, I4,), & Dosing 6V A/ Aera ' n Bldg. Sewer Holding St/ Inlet TANK SETBACK INFORMATION St/ Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic , 74r. NA Dt Bottom Dosing NA Aer NA Dist. Pipe Holding Bot. System PUMP/ INFORMATION Final Grade Manufacturer Demand ono *.C ,T• , ~l k Model Numbe .0 53 GPM TDH Lift ~Ch Friction System TDH Ft Loss Hip Forcemain Length I 16D '7 Did. Dist. To Well SOIL ABSORPTION SYSTEM BED /TRENCH Width / Length T No. Of riches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSION `J ~ DIMENSIONS LEACHING Manufacturer: SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM INFORMATION TypeO L' 3, f I CHAMBER Moe Number: System:61.r1~.'6101_1116) /4- OR UNIT DISTRIBUTION SYSTEM Header / Man4e'd - Distribution Pipe(9 ! x Hole Size x Hole Spacing Vent To Air Intake Length _21C ( Dia Length ~ Dia. Spacing LL~ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Tfted pth O ver xx Depth xx Seeded / Soddched bbl/Trench Center /Trench Edges Topsoil ❑ Yes ❑ No es Lj NO COMMENTS: (Include code discrepancies, persons present, etc ' j = J t - CI'1 /`1J Z J l L l i G V '~L J Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05/91) ' Date Inspector's Signat re Cert. No. L~Z T t ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: cc" e L(?d7~4"~n~ lbTepar I+ st~? . 30.16W r P AMSEWAO SYSY a County: Labor and Human Relations INSPECTION REPORT Safety and Buildings Division ST. X (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 193405 Permit Holder's Name: ❑ City ❑ Village f Town of: State Plan ID No.: lev.: AN _N RT H Emerald Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA A9300374 TYPE' MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. AirI to ntake ROAD Dt Inlet rl Septic NA Dt Bottom Dosing . NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft mead Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type O CHAMBER Model Number: System: OR UNIT DISTRIBUTION SYSTEM Header /Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length _ Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed/ Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Emerald-17.30.16W, NW, NE, 160th Avenue Plan revision required? ❑ Yes ❑ No T~ I Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert No. t ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: SANITARY PERMIT APPLICATION couN In accord with ILHR 83.05, Wis. Adm. Code 4,~ C,~ 70ILHRO STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than / !P3 50 S 8% x 11 inches in size. ❑ Check If revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PRROPERTY TION s' ,e R /4, S 7 T30, N, R 'G E (or) PROPERTY OWNER'S MAILING ADDRESS LOT # 70CK# 0 - P, ®;c ~ 3 CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER II. TYPE OF BUILDING: (Check one) ❑ State Owned ❑ V LLLLAGE : NEAP EST ROAD-~~ Ct(-'q~} : al ❑ Public lJ 1or 2Fam.Dwelling-#of bedrooms ~ PARCEL TAXNUMBER(S) 010 1040_ PO-ew III. BUILDING USE: (If building type is public, check all that apply) 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ® New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 p❑ Seepage Bed 21 El Mound 30 El Specify Type 41 [_1 Holding Tank 12 9 Seepage Trench 22 JE9 In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM EL V. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) rpp ELEVATION QO f~Q / / Q ♦ Feet im/ r / Feet VII. TANK CAPACITY Site in allons Total #of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name oncret Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank ~L- &2 /!r $ r'e Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's ignature: Stamps) MP/MPRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Tip Code)* C9✓ 4- ~ zd ki 47 7 2 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate s ue Issuig Agent Signature (No Stamps Approved ❑ Owner Given Initial Surcharge Fee) of & J 93 Adverse Determination d t/ 7 T X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and aocurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete of bedrooms if 1 or 2 Family Dwelling. III. Building use. if building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8'f x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. iGROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of :standards. i I SBD-6398 (R.11/88) I 1 ° rVdl Tdsc.a C e o D n ~ b r6ny O ~ ~ 4.1 ®n rya m r-4- J o F C R©SS c~l``i CID e nc S ys 7-e rsZ Fresh Air Inlets And Observallon Plp• r Approved Vent Cap Minimum 12" Above Final Grade 4" Cost Iron 20 - 42" Above Pipe - Vent Pipe To Final Grade Marsh Noy Or Synthetic Covering min 2" Aggregau Over Pipe _ Distribution o 0 0 Too Pipe g" Aggregole a Perforated Pipe Belay Bsneelh Plit '-Coupling Terminating At 0 Botlom 01 System ~ / ~L ~✓aT c Ica, ~'oFRack { Min DIS't"RIgUTIOU PIFE TO BE AT LEAST tAICHES BELOW ORIGIAJAL GRADE AWL, AT LEAS-r20 INCHE ; BUT 110 MORE THAI) 42 IAICIIES BELOW FINAL GRADE MAXIMUM WN OF EXCAVATIOP F'RoM ORI&WAL f RADF. WILL BE L INCHES MINIMUM ®EF" of EXCAVATION FROM 0K1(, tjL CRADE WILL BE , INCHES SIGIJED: LICEUSI- AJUMBER: DATE: PAGE 0 w E~ PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS T VEIJ CAP 4"C.I. VENT PIPE WEATHER PROOF APPROVED LOCKING JUNCTION BOX MANHOLE COVER s 25, FROM DOOR,; 12"M I L1. WINDOW OR FRESH AIR INTAKE i GRADE I 4°MIIJ..:i 4111 COIJDUIT - - - 18"MIAI. ~Z~ 1 PROVIDE I INLET r' AIRTIGHT SEAL I I i I APPROVED J011JTS' APPROVED JOINT A I III W/c.I. PIPE" ' 'r W/C.=: PIPE: : v = I III ALARM` EXTENDIAI6 "3 'SOLID I ltI4 EXTENDING 3 ¢ ONTO-SOLID OMT4 SOLID SOIL, y ON t j ~ I ELEV. FT. PUMP--~_ _J OFF ,y D CONCRETE BLOCK v ;r ,RISER EXIT PERMITTED OtJLy IF TANK MANUFACTURER HAS SUGH APPROVAL SPEC,IFICATIOMS h x~ SEPTIC f fi. DOSE .~o PI-K DAB k a TANKS MAIJUFACTURI^R:.." I~IUMBER OF DOSES, T.ANKSIZE GALLOWS DOSE VOLUME INCLUDIN6 BACT(F,t.OW GAt►, L~ARM MANUFACTUREK:V MODEL IJUMBE ;.R: CAPACITIES: A= _ INCHES OR .~L GALLON B =-----INCHES OR GALLOAI Y yFE SWITCH (n~{- tr= f© INCHES OR 1 60 GALL0 s A PUMP MANUFACTURER: /-u MODEL NUMBER:, D=~INCHES,OR -~-L- GALLONS NOTE: PUMP AND ALARM ARE TO,BE~'. SWITCH 7BPE: /n_ x e-li - y O INSTALLED OU SEPARATE CIRCUITS MINIMUM DISCHARGE RATE„"..~GPM r VERTICAL DIFFERENC6 BETWEEN PUMPrOFF AND DISTRIBUTION PIPE.. FEET -I- MIIJIMUM NETWORK SUPM,5,PRESSLIKE 2.5 Ff=ET -I- -_J6;7_ FEET OF FORCE MAIN X F~100FLFRICTION FAC70R.. FEET TOTAL D9NAMIC. HEAD -L , FEET INITE:RMAI_ DIMEWSIONS OF TAAIK: LEhJGTH-- -f- ;WIDTH --';LIaVID DEPTH Al VAT ~~5;3 IGNED: LICEOSE MUMBER' S ~r I ~ x U.J w U-1 HEAD CAPACITY CURVE a'~a v4 LL 5 6'53-55,, SERIES a/8 rs 25 TOTAL DYNAMIC HEAD/ i 4% FLOW PER MINUTE EFFLUENT AND DEWATERING a HEAD CAPACITY + UNITS/MIN --11/z V, 6 20 - Q 11 1/2'N PT FEET METERS GAL LTRS 43/,6 5 1.52 43 163 W V 16 - 3.05 34 129 15 _4..57 19 72, Q 15 19.25 5.87 0 0 Z 4k. Q 10- 2- 5- 9 F- 15/16 0 US 10 20 30 40 50 3% 4 GALLONS LITERS 0 80 160 FLOW PER MINUTE t CONSULT FACTORY FOR SPECIAL APPLICATIONS e Piggyback Mercury Float Switches • Available with special cord lengths of 15', available. 251, 35' and 50'. ; • Variable level long cycle systems • Alarm systems available. available. • Duplex systems available. Standard cord length automatic 9 ft. 3 V Standard cord length - non-automatic 15 ft. `SELECTION GUIDE < 'r- M53/55 SERIES' Control Selection 1. Integral float operated mechanical switch, no external control required. Model Volts-Ph Mode Amps Simplex Duplex 2. Singlepiggyback wide angle mercury float switch or double piggyback mercury float' M53/55 115 1 Auto 8.0 1 or l &7 - switch. Refer to FM0477. N53/55 115 1 Non 8.0 2 or 2 & 6 3 or 4 & 5 3. Mechanical alternator 10-0072 or 1D-0075. D53/55 230 1 Auto' 4.0 1 or 1 & 7 - 4. Bee FM-712 for correct model of Electrical Alternator, "E-Pak E53/55 230 :-1 Non 4.0 2 or 2 & 6 3 or 4 & 5 5. Sensor mercuryflaatawdch 10-0225 used as a control activator, with E-Pak (3)or(4) r float system. 53 Series - Wt. 23 lbs. - .3 H. P. 55 Series - Wt. 25 1 bs. - .3 H.P. 6. Four (4) hole "J-Pak", junction box, for watertight connection or wired-in simplexor T' duplex operation. P/N 10-0002. _ J 7. Two (2) hole "J-Pak", junction box, for watertight connection or splice, P/N 1G-0003";;- For Information on additional Zoeller products refer to catalog on Combination Starter, FM0514; CAUTION Piggyback Mercury Float Switches, FM0477; Electrical Alternator, FM0486; Mechanical Alterna- All Installation of controls, protection devices and wiring should be done by;s qualified t nator, FM0495; Alarm Package, FM0513; Sump/Sewage Basins, FM0487; and Simplex Control licensed electrician. All electrical and safety codes should be followed inaddltlontothet Box, FM0732. a" - most recent National Electric Code (NEC) and the Occupational Safety and Health Act. (OSHA). RESERVE POWERED DESIGN For unusual Conditions a reserve safety factor is engineered into the design of every Zoeller; pump. 3280 Old Millers Lane Manufacturers of ZZ71Z-M_ff TZ7. P.O. Box 16347 • Louisville, Kentucky 40216 (502) 778-2731 • FAX (502) 774-3624 X10114 irr PUMPS S,yer /P,79 a~ ~ ~4i ' - _ `fit t / I i0 ~ 1 ~f~• ~ \ / I i ~ / 1 ~ti F i v ,a1 -g ,l , O •i y }t f V" b, k ~ r y b t_ J r y n it n r. ! s °j1 'k f ~f `z~• > z; Y ra "}r .C r 'r 4 g•,Z:{£~,tz~3 • r~ ~;r T/lVti SP'ECIFICA,'fiOlS~wg .3 1 y r _ _ } ro r CAPACITY 1200/,50 GALLONS INLET AND ~OUjLET C(1NCRETE,STRGTH:'•5000 PSI 4" .BORE WITH,.=STOP,FOI.TYSEAC } REINFORCEMENT : FERNC4 CASKET " F~CgVER #G,REBAfIN LET'AN,D:OUTLEI BAFFLES, 4 °'T~NK 6X6/10 GA. WIRE MESH P.V.C `.MEETSWI..D.I.L H R" ANDS -DIMENSIONS: MN M.P C.A. SPECIFlCATI ~'n. " .a WALL: 2`LENGTH: 151 LIQUID CAPACITY: BOTTOM:3' `,',WIDTH- 25.40 GALJINCH`(SEPTIC} ` COVER 5" BELOW INLET: 53". 16.13 GAL/INCH (PUMP) k HEIGHT 66724" I.D. 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D0 d 0 D 14z I IJ o n cr 1040 ~o 3 13 N ~ j p ~o t ~ ~ c6 6 ~ I V1 r i I ° /1 C Q- o v CF i a a (D s r 0 ~ n IV) tjc LI) m~ m 77 N N V, M V, L-3 -i I S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER KE hi nt e 7-4 N i) ADDRESS FIRE NUMBER CITY/STATE /3At,l~ GA.' r ZIP 3'SYf.=mss PROPERTY LOCATION: rJuj-1 1/4, ME 1/4, SECTION i 7 , T ETC?N-R-LL-_W TOWN OF L: ln- C St. Croix County, SUBDIVISION , LOT NUMBER Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification 'form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1). the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix Co. Zonin Officer within 30 days of the three year expiration date. SIGNED• / s' - DATE: / 7 f 2-3 St. Croix co. Zoning office 911 4th St. Hudson, WI 54016 v STC-100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the pormit issuance. Should this development be intended for resale by owner/contractor,(spec house), then►a second form should be retained and completed when the property' is sold and submitted to this office with the appropriate deed recording. owner of property %~-c rvn~ 7"f# i. k?c -,J f~c Location of property u% 1/4 N~ 1/4, Section, T s'~ N-R W Township gff,, -1 Z_1Z-A L ; Mailing address Address of site subdivision name Lot no. Other homes on property? yes No Previous owner of property Total size of parcel Date parcel-was created Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? Yes ~ No I Volume (7and Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER & THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. I PROPERTY OWNER CERTIFICATION I(we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded Ltn the office of the County Register of Deeds as Document No. 7 h l ? 3 , and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of County Register of deeds as Document No. y 70 / 7 Signature o applicant Co-applicant Date of Signature Date of Signature t V DOCUMENT NO. STATE BAR OF WISCONSIN FORM 3-1982 THIS SPACE RESERV¢D FOR RECORDING DATA = QUIT CLAIM DEED 470173 r VOL 905 wa -5 REGISTER'S OFFICE tl ~I Julie C. Speer, single woman ST. . CROIX CO.' W1 ~I Recd for Record ~i Of JUN 071991 II 8:30 A. M quit-clalms to Kenneth- D_...Speer.,...a..sing ie..man i ftww Of Deeds I~ i the following 'escribed real estate in ..5 ><Oi}f . County, - - - State of Wisconsin: RETURN TO Donald J. Fast ij Office Park, Box 546 Northeast Quarter (NE}) P f Section aldld'Ls__1~TJ~_ 5002_`_-: Seventeen (17), Township Thirty (30), Radge Fifteen (15). I' Tax Parcel No: ( Ii f ***THIS DEED IS MADE PURSUANT TO THAT DIVORCE JUDG,ENT GRANTED ' 5/20/91 AND IS FEE EXEMPT PURSUANT TO SEC. 77.25(8)*** I~ I t i' li f i i This is.. not homestead property. i6ix (is not) h Dated this day of ..^..t^r..................-----.................-, 19..91.. (SEAL) (SEAL) ulie C. Speer .................(SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT I Signature(s) STATE OF WISCONSIN M ss. C Y~ X .......................County. fiw authenticated this ........day of 19...... Personally came before me this --..............day of c sL ~ ................~4tr............... 19...(.1.. the above named . . i. TITLE: MEMBER STATE BAR OF WISCONSIN (If not authorized by § 706.06. Wis. Scats.) to me known to be the person, who executed t^e foregoing instrument' and acknowledge the Sarre. THIS INSTRUMENT WAS DRAFTED BY \.t~ J r Donald J. Fast . Office Park, Box 546 Notary Public r_ -F+mt~, Cis. galdw.i.nj ...WE -54-00.2 . (Signatures may be authenticated or acknowledged. Both My Commission is permanent.((f not, state expiration are not necessary.) date: / .3 19..i~S: ~j L eNames of persons sienloc in any -apacity should be typed or printed below their sianatures. I STATE FORM No. I - 1982 tiSt r Stock No. 13003